- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,060.00 / $5,305.00 / $18,387.00
| Facility | | $2,060.00 | $5,305.00 | $18,387.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.00 / $2,753.00 / $17,047.09
| Facility | | $687.00 | $2,753.00 | $17,047.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.00 / $13,722.00 / $30,159.95
| Facility | | $6,431.00 | $13,722.00 | $30,159.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,297.95 / $39,702.26 / $39,702.26
| Facility | | $23,297.95 | $39,702.26 | $39,702.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,665.00 / $6,665.00 / $7,390.00
| Facility | | $6,665.00 | $6,665.00 | $7,390.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,698.94 / $14,137.04 / $33,645.78
| Facility | | $9,698.94 | $14,137.04 | $33,645.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $6,729.00 / $14,415.95
| Facility | | $2,100.00 | $6,729.00 | $14,415.95 |